The Significance of Pain in Diseases of the Female Pelvic Organs *

In the diagnostic differentiation of diseases of the female pelvic organs, pain must be regarded as a symptom which plays an illusory role, for, on the one hand, it is unsafe to rule out the presence of pelvic pathology because pain is absent, or, on the other, to attempt to arrive at a clear-cut diagnosis solely upon the basis of its presence and character. Moreover, the magnitude of pain is not necessarily commensurate with the extent or seriousness of the lesion, as witness the intense pelvic discomfort of acute gonorrheal salpingitis contrasted with the painlessness of advancing cancer of the cervix. Since in the final analysis the interpretation of the cause of pelvic pain rests upon a proper evaluation of the patient's history and of the pelvic pathology, it would be futile to discuss pain as a symptom of pelvic disease without attempting to correlate this evidence with the findings upon abdominopelvic examination. In addition, since certain pelvic diseases may be present without giving rise to pain these also must be mentioned. The purpose of this paper, then, is to review the possible lesions of the pelvic organs in which pain may be an outstanding symptom, together with those in which it plays a secondary role, especially in the early stages of disease. In connection with some of the lesions certain points in differential diagnosis will be mentioned, but no exhaustive discussion of this subject will be attempted. During the reproductive period pain is frequently associated with certain anomalies of pregnancy. These possibilities will be considered first. Most familiar is the characteristically cramp-like pain located in the lower back and abdomen and associated with abortion. Vaginal examination of a patient who presents this symptom generally discloses a softened cervix, perhaps slightly dilated, and a uterus enlarged to the size found in a pregnancy of from one to three months' duration. Such pain, which is generally rhythmic, taken with the characteristic palpatory finding and a history of amenorrhea, usually leaves no doubt as to the correctness of the diagnosis. Never-